Health: The capacity to manage or cope with physical, mental, emotional, social, spiritual, and other forms of stress. The ability to recover from disease, injury, insult, trauma, and other forms of strain. Health can be understood only in relation to forseeable stressors and their consequent strains. Any living system has a state of health; e.g., a person, a family, a community, a society, the planet.
	Antonyms related to health: healthy ... unhealthy flexible ... rigid resilient ... fragile stable ... unstable vigorous ... lethargic
	Synonyms related to health: health: well-being flexible: adaptable, elastic, limber, pliable, supple, yielding rigid: impliable, inelastic, inflexible, stiff, unyielding resilient: durable, firm, solid, stout, strong, sturdy, tenacious, tough fragile: decrepit, delicate, feeble, flimsy, frail, infirm, weak stable: secure, stalwart, sure unstable: insecure, shaky, unsure vigorous: dynamic, energetic, vital lethargic: sluggish, stupid, torpid
	Concepts related to stress and strain, and not to health: discomfort ... comfort disease ... ease disorder ... order imbalance ... equilibrium strain ... repose tension ... relaxation

Geoff Chesshire, August 22, 2003

PartySmart’s mission is to empower youth to take responsibility for health, safety, and respect, for themselves and for their communities. It is therefore important to be clear about which definition of health we choose as our goal. Some would encourage us to take responsibility, while others would lead us delegate this to health professionals, agencies, and industries. Clearly we must choose from among the former, to be consistent with our mission. If we choose a definition that also subsumes safety and respect, so much the better; and better yet if our definition applies equally to individuals and communities. This is very important, because it helps us to understand our mission, and to choose program goals that support this mission.

The World Health Organization’s definition of health is rather dated (1946), although it is still considered progressive for including a social dimension:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

This is somewhat circular, defining health in terms of its synonym, well-being. However, the main problem is that this definition implies that health requires the absence of disease. This might lead someone to blame their ill health on a disease, and delegate to someone else the responsibility for eradicating it. It might lead us to feel healthy while we sit like couch-potatoes in complete comfort, expecting others to serve our every need. Delegation of responsibility disempowers the individual, making the WHO definition inconsistent with our mission. In addition, this definition applies to individuals and populations, but not to communities, making it even less suitable to our purpose. The American Journal of Health Promotion definition is somewhat more progressive, including more dimensions of health:

“Optimal health is defined as a balance of physical, emotional, social, spiritual, and intellectual health.”

However, this is completely circular; it might as well say, “You’re healthy if we say so,” or “You’re healthy if your lifestyle is like ours.” This, once again, disempowers the individual.

Clearly we need a definition that empowers individuals to take responsibility for their health. The one I like best so far comes from UBC professor James Frankish, quoted in “Health Impact Assessment As A Tool For Population Health Promotion And Public Policy,” who defines health as

“the capacity of people to adapt to, respond to, or control life’s challenges and changes.”

This definition is completely consistent with our mission, insofar as it addresses individual and population health. However, it fails to address the issue of community health. A healthy community is not the same thing as a community of healthy individuals. In fact, such a community is probably not healthy at all, because it forgets how to help those in need. A healthy community thrives while accommodating diversity among the individuals comprising it, including diversity of individual health. The definition of community health that I like best so far comes from UC Berkeley professor Leonard Duhl in his book, The Social Entrepreneurship of Change:

“A Healthy City/Community is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential.”

I propose to synthesize from these a simple, yet powerful, definition such as:

Individuals, communities, and all living systems encounter stress and strain in a wide variety of forms, so this definition applies as well to communities as to individuals. We need to distinguish between stress and strain: stress causes strain, and strain is a consequence and indicator of stress. We can sometimes manage stress, but we cannot rely on prevention. Part of growing up is testing ourselves under stress, taking risks and learning from our challenges and mistakes; we cannot otherwise become healthy adults. We can reduce strain to the extent that we learn to cope with the stresses that cause it, using our resources of confidence, strength, and vitality; and in the case of communities, our caring, sharing, and solidarity. However, sometimes we can recover from strain better using our adaptability and flexibility, yielding like the reed in a storm that may uproot the oak. All of these abilities contribute to our health. Disease and injury are examples of strain, which may be exacerbated by ill health. Even a healthy person may become injured or suffer disease, or a healthy community may suffer a disaster. However, a measure of health is the ability to recover from these and other strains.

Any definition of health must take into account the range of anticipated stressors. In an otherwise healthy system, when unanticipated stressors are discovered that are beyond the ability of the system to cope, the system becomes unhealthy. For example, the dinosaurs were healthy until their environment changed. Some stressors actually contribute to health, such as physical exercise (taking into account the risk of injury) and learning from our mistakes (nothing ventured, nothing gained). The distinction between internal stressors (our personal choices) and external (environmental) stressors is somewhat arbitrary, and depends on the extent of our understanding of and influence over them. For a stressor to be considered internal, we must have both understanding and influence. This gets into the somewhat anthrocentric philosophical difficulties of free will, good and evil. For example, is body piercing to be considered creativity or self-mutilation, and who decides this? Who chooses which drugs are beneficial, and under what circumstances? In general, who decides which physical, mental, spiritual, or other ways of being are desirable or permissible, and by what means accessible? In order to be healthy, it is important for us to take responsibility for our own health to the extent that we have influence, and to seek and accept help from others when we need it.

In our society, we experience daily the extremes of conservative and liberal notions of community health. An extremely conservative notion might be that we can make a community healthy if we exclude, remove, or segregate unhealthy or otherwise different individuals. This leads to severe discrimination, as successively stricter definitions of normal or healthy individuals are applied, destroying communities in order to save them. This is externalization of internal stresses, denying responsibility for coping with them. On the other hand, an extremely liberal notion of community health might be that we can make a community healthy by expending massive resources to guarantee individual health, and by preparing for all worst-case scenarios, no matter how unlikely they be. This approach weakens the system to the point where its coping mechanisms become ineffective. This is internalization of external stresses, taking responsibility beyond the ability to influence. Both of these extremes are examples of unhealthy communities. Oddly enough, when it comes to the use of some drugs, our society takes both extreme approaches at the same time: we incarcerate thousands whose drug use we don’t like, and we spend millions on ineffective prevention schemes. Somewhere in between the extremes, there must be a balance between individual responsibility for individual health, and confidence in the compassion, goodwill, and preparedness of others in the community to care for the individual in need. In order to be healthy, a community must be capable of caring and must practice this response to individuals in need.